Life, Love & Health

TRT: 10:59

[Music plays]

CS: I’m Christopher Springmann and you’re listening to Life, Love and Health Special Edition. We’re broadcasting from Albuquerque, New Mexico, from the American Medical Association’s 29th Annual Medical Communications Conference. My co-host is Dr. Teresa Knight, an OB-GYN, obstetrician-gynecologist, who practices in St. Louis, Missouri. It’s so nice to have you here. It’s a joy.

TK: It is really a pleasure to be here.

CS: And we’re speaking with one of your favorite colleagues. And who might that be?

TK: Oh, this is Dr. Jill Grimes. And we just couldn’t get enough of her. It might have been a seductive delusion. She has written a wonderful book, in fact, entitled Seductive Delusions.

CS: Tell me, Doctor, what are you boarded in?

JG: I am a family medicine doctor.

1:03

CS: And you practice at West Lake Family Practice in…

JG: In Austin.

CS: …beautiful Austin, Texas.

JG: Hm-mmm.

CS: You wrote a very important book called Seductive Delusions: How Everyday People, real people, Catch STDs. Sexually transmitted diseases. Tell me, doctor, how do real people acquire these? I thought it was, well…?

JG: It’s the old-fashioned way.

CS: Yeah. The old-fashioned way. What is the old-fashioned way that eludes people that perhaps deludes them into believing that if I practice this type of sexual activity, then I won’t get STDs?

JG: Well, there is two parts to that. One part is that people think that what they’re doing is not risky. They feel like if they’re not actually having intercourse, traditional old-fashioned intercourse, that they can’t catch an STD.

1:52

CS: Well, there are people who believe if they have anal sex, then they can retain their virginity because that’s not real sex.

JG: And that’s exactly what I’m talking about. Oral sex and anal sex. And the truth is that you absolutely can catch diseases that way. We see genital herpes and warts that way all the time.

CS: But, Doctor, I used a condom.

JG: Yeah. Well, guess what? These diseases are spread outside the area that a condom can possibly cover. And so they can’t protect against all the diseases.

CS: And there are several upper body extremities that can spread bodily fluids, aren’t there?

JG: Well, you know, it’s interesting. The – when talking specifically about intercourse, either anal or vaginal intercourse, the groin – wherever the groin touches, you know, those viruses are happy to live in that groin, that moist, dark area of the groin. And in the mouth, you know, there is not a whole lot of difference between the moist dark places around the mouth. Now, of interest. I did have an unfortunate friend in residency who did get an STD in his eye.

CS: Really?

JG: Absolutely. It was a – I mean we see…

CS: Tell us about that.

2:58

JG: Well, we see a couple different ones. I’m not sure what your friend had, but you can get gonorrhea or chlamydia very frequently. Well not very frequently, but if you’re going to have an eye infection that is a sexually transmittable one, those would be the more common ones.

TK: Yes, and in fact chlamydia, when a woman has chlamydia and gives birth vaginally, that chlamydial infection can be transmitted to the baby’s eyes and can cause blindness. And still to this day it is routine care to put Neomycin drops, antibiotic drops, in the baby’s eyes to prevent blindness.

CS: How do people determine that they may have a sexually transmitted disease? Let’s say from an early diagnosis standpoint before the symptoms become alarming.

3:40

TK: There may not be any symptoms ever. This is what is so tricky about STDs. So many of them are silent. Ninety percent of people with genital herpes are unaware that they have it. With chlamydia, 75 percent of women and 50 percent of men don’t know they have it.

CS: And cervical cancer is difficult to diagnose, isn’t it?

JG: Not difficult to diagnose. Not at all if you’re going in for regular exams. But certainly doesn’t have symptoms.

CS: It’s asymptomatic.

JG: And HIV. You may not have symptoms for years. Or if you have an initial infection with HIV, it may simply be that you feel that you have the flu. And, you know, particularly college students and young professionals who get cold symptoms, sore throats, swollen glands may or may not even see a doctor. And if they do, they may or may not be thinking about HIV. After that initial infection, they may be completely without symptoms for years. And so we need to really straighten out the seductive delusion, if you will, that you can tell by looking who might have an STD because they’re everywhere. I’d like to share a story with you, if I could.

CS: Please.

4:52

JG: I saw a young lady who is 19. And it was getting near the end of her freshman year in college. And she had been my patient. I had seen her when she was in high school. And she came in at the end of her freshman year of college just for her annual exam. She had absolutely no complaints whatsoever. But I did a pelvic exam on her as part of her physical because she had had a sexual partner. And, in fact, she had, again, no symptoms at all and came back positive for chlamydia. But it also came back positive for HIV. And here’s the thing, and this is what I want our listeners really to hear and absorb: When we went back and talked about how many partners she had had, she had had three. Her high school boyfriend. I asked, “Do you happen to know if he’d had any previous partners?” And she immediately said yes. He’s had ten. And then I said – then she went to college – and this is not a promiscuous young lady. But she did what many girls do. The thing of well, I’ve lost my virginity and, you know, it’s kind of what the hey. And so her next boyfriend she did also have sex with and broke up with him because he was cheating on her. And I said, “How many partners had he had?” Twenty. Then six months later – she didn’t date people for awhile, and if she did, she wasn’t intimate with them. Six months later she had a new boyfriend. The love of her life. The man she wants to marry. And that’s who she was dating when she came in to see me. And I said, “Well do you happen to know how many partners he had had?” And she said well actually closer to 30 he thinks. So here’s the thing: This young lady had slept with three boys – men. But total they had slept with 60. And what do you think the odds are that every girl they slept with was a virgin. I mean I have to say zero.

6:42

CS: So there’s a multiplier effect.

JG: So this is…

CS: What term do you use?

JG: Well, you know I – for people of a little older generation I ask them to remember the O.J. Simpson commercial: I tell two friends, and you tell two friends, and so on, and so on. So I think all the parents listening will remember that. For kids, I just want them to work out the math of that. And they need to understand when you sleep with someone, you sleep with every single one of the people that they’ve slept with, and the people that they’ve slept with, and so on, and so on.

CS: Dr. Knight, you’ve been nodding for the last couple of minutes. This story does not sound unusual, does it?

TK: Oh, no. Not… nodding because in just letting her get through it. Because this is a point that I try to hit home as much as I can. And really the reason why it is a point so difficult to drive home is because we are meant to be sexual people. We are meant to want to have sex. And so we have to be logical about this before we get in the bedroom.

7:42

JG: That’s right.

TK: And we have to be thinking…

JG: And we have to be grownups if we’re doing grownup behavior. And both get tested.

TK: Absolutely. And the other thing I think is really important is that even if your partner says, “I’ve been tested”, we don’t routinely test boys for HPV or the human papillomavirus. We don’t know. We don’t routinely test boys for herpes.

CS: And there’s also a lag time, isn’t there, with…?

TK: And there’s a lag time for HIV. That’s correct.

CS: Six months is it or… plus or minus?

TK: At least.

8:12

JG: Right. So, even if both people have been thoroughly tested. And then the other thing is many women think, “Oh, I had my pap smear, therefore I was definitely tested for all STDs.”

TK: And no, we don’t test. Well because the human papillomavirus is so common that girls will acquire it. In fact, there’s a beautiful study where they checked girls for the human papillomavirus when they entered college and then checked them again when they are exiting college. And the majority of them did not have the virus when they entered, but the majority of them, 80 percent in fact, had it when they exited.

JG: Right.

CS: Dr. Grimes, author of Seductive Delusions, disillusioning. What is the bottom line?

JG: The bottom line is that we need to understand that anybody can have an STD. You cannot tell by looking. They cross all boundaries. And so you need to be tested. You may or may not have symptoms. Let’s be smart. And let’s spread knowledge, not disease.

CS: That is a very catchy phrase and – but it is not a cliché. It is definitely a truism. And what are your thoughts, Dr. Knight?

9:25

TK: I agree with that wholeheartedly. I wanted to actually point the listeners to her web site. And if you could tell us that right quickly, that would be fantastic.

JG: Thank you. It’s www.jillgrimesmd.com.

CS: It has been a joy having you on the show. This is tough talk, isn’t it?

JG: It is, but it’s very important.

CS: Are there parents who occasionally engage you to have this tough discussion with their children because they can’t quite find the words?

JG: Frequently. And that is a wonderful recommendation. You know, your gynecologist, your pediatrician, your family physician, we’re all comfortable with this discussion. So if you are uncomfortable or you feel you don’t have all the knowledge, please ask your doctor.

CS: For more information on Dr. Grimes’ book, Seductive Delusions, or any of our guests and shows, log onto healthradio.net. I’m Christopher Springmann at the 29th Annual American Medical Association Medical Communications Conference. My co-host is Dr. Teresa Knight, OB-GYN. You’re listening to Life, Love and Health Special Edition. Dr. Knight, it’s been a joy having you here.

10:30

TK: It has been a real pleasure. Thank you.

CS: And I like your friends. They’re wonderful people with good advice. Thank you.

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Jill Grimes, MD, is a board-certified family physician with a passion for preventative medicine. She shares her opinions about all things medical, breaking down complex clinical issues into common sense explanations. Her blog is for informational purposes only, and should not be considered medical advice, as you (the reader) hereby agree that there is no physician-patient relationship. Please do, however, use this information to start a discussion with your own health care providers.